The BC Supreme Court Has Ordered Health Canada to Let Addicts Access Prescription Heroin

Image via Flickr user stevendepolo.
Despite a major setback last November, a small group of entrenched drug users in Vancouver recently secured a legal victory against the federal government. Last Thursday, the BC Supreme Court ordered Health Canada to quit obstructing access to prescription heroin for these patients.

The ruling is a small step forward in a larger legal battle about whether or not patients have a constitutional right to legal heroin. Chief Justice Hinkson said that “irreparable harm” is being caused to the plaintiffs by blocking diacetylmorphine-assisted therapy (prescription heroin) while they wait for their case to be heard.

For a few of those with chronic opiate dependencies, traditional treatments like methadone don’t work. And withholding the medication is making them sick.

Dr. Julio Montaner, Director of the BC Centre for Excellence in HIV/AIDS, was exuberant. “We are delighted to see that once again evidence trumps ideology,” he told me. “The court recognizes that these are health issues… rather than the prejudices of the government of the day.”

Doctors are now moving to get the plaintiffs back into treatment with prescription heroin.

Lawyer Adrienne Smith from Pivot Legal, which is assisting with the case, was frustrated about having to go to court on “a medical issue that should be addressed by doctors, not police officers.”

“This isn’t a way to put heroin on the street,” Smith said. “This is a treatment for a small group of people who don’t react well to traditional treatment.”  Smith sees policies opposing harm reduction as “needlessly punitive to drug users. Punishing people for trying to be well is not a way of moving forward.”

Chronic Addiction

After four decades of chronic heroin addiction, Douglas Lidstrom’s health, family, job prospects, and housing had all deteriorated. He’d tried to quit; tried the methadone program six times; tried detox dozens of times. Nothing worked.

Then, Lidstrom joined a prescription heroin trial and everything changed. He got healthy. He got stable. And others did too.

According to Professor Martin Schechter, the founding Director of the School of Population and Public Health at the University of BC “[prescription heroin, or diacetylmorphine treatment] is not simply the administration of a drug, but the opportunity for patients to benefit from up to thrice daily contact with doctors, nurses and counselors; the breaking of their cycle of criminality, sex work, jails and hospitalizations, and the stabilization of their previously chaotic lives which made improved health outcomes extremely unlikely.”

But the Government of Canada is against prescription heroin. Last year, the Minister of Health blocked diacetylmorphine for those exiting the drug trial and seeking special access to continue treatment. So, Lidstrom and the other study participants took the government to court—and won.

David Murray was another of the plaintiffs. Murray has been injecting heroin for 42 years. He’s spent time in jail. He has Hepatitis C, type 2 diabetes, and suffers from depression. Murray has often been homeless. He knew heroin was ruining his life, and tried the methadone program ten times. It didn’t work.

Prescription for Success

Then, like Lidstrom, Murray found the prescription heroin study. “I discontinued any criminal activity, and discontinued using any illicit heroin or other opioids. I reconnected with my family and began repairing those relationships,” he said in an affidavit.

David Byres has seen these changes again and again. Byres is VP Acute Clinical at Providence Health, which ran the two prescription heroin studies: the Study to Assess Longer-term Opioid Medication Effectiveness (SALOME) and before it, the North American Opiate Medication Initiative (NAOMI).

“Prescription heroin is tightly controlled under the supervision of our medical and nursing staff. It doesn’t leave the clinic. Many patients have to come two or three times a day to the clinic. We monitor it and track it. We assess them when they come in. Our clinic has mental health counselling, addiction counselling,” he said.

But after patients finished the last study, they were cut off.

Lidstrom worried about going back to a life of chaos—about getting robbed, assaulted, arrested and even overdosing. “I try not to think about what will happen if I cannot get access to diacetylmorphine. I am worried about my well-being and think I might have to turn to running scams… and will end up in jail.”

Byres was worried too. “People got sick again,” he said.

So doctors appealed to Health Canada to let them continue prescribing heroin to some of the participants that had moved through NAOMI & SALOME. At first, government officials said yes, but then politics got in the way.

Backlash

The Minister of Health intervened, stating that the prescription of heroin “is in direct opposition to the government’s anti-drug policy… Our policy is to take heroin out of the hands of addicts, not to put it into their arms." The government quickly drafted new regulations, blocking access to diacetylmorphine.

But it’s not just prescription heroin. The governing Conservatives oppose harm reduction generally, including North America’s only supervised injection site. At InSite, medical professionals oversee intravenous drug use, but no drug is dispensed or prescribed. The idea is to reduce overdose deaths and the spread of HIV & Hepatitis C. The government fought and lost a protracted court battle to shut down InSite. The party’s website encourages supporters to sign-up to “keep heroin out of your backyard" even the small crack pipe vending machine provoked outrage.

“What we see may be more ideology than evidence,” said Byres. “There’s some stigma around addiction, around heroin. For people with a long history of smoking, often how we begin to treat that addiction is with nicotine patches, or other substitution therapy.” Treatment with diacetylmorphine and methadone both operate on the same principle.

Withdrawal

After getting cut off, Douglas Lindstrom was soon injecting street drugs again. His health suffered, he lost weight and he became disconnected from his family. He was back to the cycle of dope sickness and scrounging money for heroin. And he wasn’t the only one.

Deborah Lee Bartosch, another of the plaintiffs, said in her affidavit: “heroin addiction has taken a large toll on my life. I am tied to the drug. It feels like a monkey on my back, and I cannot go without it.”

“When I do not have heroin, I feel 100 years old,” she said in her affidavit. “I cannot do anything—even walking feels painful. Without heroin I feel pain deep in my bones.”

The Struggle Continues

Murray, Bartosch and Lidstrom all want to improve their situation and to access the only treatment they have experienced that will let them do it. Ultimately, Lidstrom wants to give up heroin entirely.

“We’re pretty happy,” Byres said of the decision, “It’s been a very distressful time for [clinic staff] trying to treat these people, seeing them not doing well, knowing there’s an effective treatment and telling people they cannot give it to them. [Now] they’re going to be able to treat people effectively.”  @garthmullins